WEB OF CAUSATION BETWEEN DIETARY PATTERNS AND CHILDHOOD OBESITY: APPLYING HILL'S CRITERIA
Since their publication in 1965, the Bradford Hill criteria for causality have been largely used as a framework for causal inference in epidemiology. We aim at employing this classical approach to shed new light onto the web of causation of childhood obesity. Although the fundamental cause of obesity is the long term imbalance of energy between needs and intake, this medical condition is multifactorial in origin, influenced by genetic, behavioural, socioeconomic, and environmental factors. This imbalance leads to accumulation of excessive fat tissue. Observational studies tend to mostly quantify any possible association between dietary factors and accumulation of fat tissue. On the other hand, multivariate analysis proved some of these associations to be spurious, therefore prospective trials are needed to demonstrate causality. Short term experimental studies have been conducted to identify unique dietary patterns change on specific outcomes, but long term, community based studies would offer more comprehensive answers on the dietary pattern effects.We discuss the applicability of Bradford Hill criteria by using examples of dietary patterns and accumulation of body fat in excess as exposure-response associations. We also put forward and analyse the evidence that prospective studies would bring, as foundation for future interventions.